9 unexpected side effects you can experience on the powerful acne medication Accutane

Isotretinoin is the prescription acne medication better known as Accutane.

It can cause some side effects that seem totally unrelated to your skin, like dry eyes, nosebleeds, or thinning hair.

Most people tolerate isotretinoin very well, a dermatologist told INSIDER.

If you’re struggling with side effects, your doctor can adjust your dose.

Isotretinoin – the prescription acne pill better known by the now-defunct brand name Accutane – is well-known for its ability to clear severe, treatment-resistant acne. Many patients who take the medicine, typically for a four- to five-month course, experience a prolonged (sometimes permanent) disappearance of their blemishes.

Just like any medication, though, isotretinoin can cause side effects, including some that you might not expect – like muscle pain and dry eyes – given that it’s a medicine for the skin.

The presence of side effects doesn’t mean isotretinoin isn’t worth taking. Just about every acne treatment has benefits and drawbacks, and for a lot of acne patients, isotretinoin’s side effects are worth the results.

“It’s very well tolerated, and in many cases is going to be the only treatment that’s going to put patients’ acne into remission,” dermatologist Dr. Kathleen Suozzi, assistant professor of dermatology at Yale School of Medicine, told INSIDER.

Still, side effects are a reality of undergoing the powerful therapy. Here are nine that are possible while taking the drug.

1. Dry skin and chapped lips

Sebum, the oily substance secreted by small glands attached to your hair follicles, keeps skin from drying. But an excess of sebum contributes to acne by making dead skin cells stick together inside pores, promoting to the clogs that lead to zits, according to the American Academy of Dermatology.

One of the ways the isotretinoin fights acne is by dramatically reducing the amount of sebum the skin produces, Suozzi explained to INSIDER.

This means that dry skin and chapped lips are “almost a guaranteed side effect,” of the drug, she said. So it’s important for isotretinoin patients to slather their skin and lips in moisturizers and emollients. Some cases, however, may require extra intervention.

“If [chapped lips] are severe, I will sometimes prescribe an ointment that contains hydrocortisone,” Suozzi said. “That will help decrease the discomfort.”

3. Nosebleeds

Isotretinoin can also have a drying effect on your nasal mucosa – a.k.a. the tissue that lines your nasal cavity. That dryness may result in nosebleeds.

“Your mucosal skin is just like your regular skin, it’s just slightly different in its structure,” Suozzi said. “[Isotretinoin] affects the thickness of the skin and how it matures. And so the barrier is thinned a bit, which can also contribute to its fragility. The reason you get nosebleeds is because of that dry nasal mucosa.”

4. Thinner, more fragile nails

“Think about the nails as an appendage of your skin,” she said. “The area that makes the nail, called the nail matrix, is a type of epithelial tissue just like your skin. So it’s all potentially affected [by isotretinoin].”

5. Thinning hair

It’s also possible to experience some hair thinning while on isotretinoin, dermatologist Dr. Joshua Zeichner previously told INSIDER. But he added that this effect is typically mild and goes away once the medication is stopped.

6. Pain

Isotretinoin patients may also experience muscle pain and, more rarely, joint pain. But experts still don’t know exactly why this happens, according to Suozzi.

“It’s more common to have the muscle pain in patients that have more physical activity,” she said. “Those seem to be the patients that are a little bit more at risk. It’s certainly something that we screen for every time we see a patient for follow up on isotretinoin … If a patient is having true weakness because of the muscle pain, then you might discontinue the medication.”

She added that some patients have also reported other vision changes, like sensitivity to glare or changes in color perception, but these are not common.

8. High triglycerides

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Triglycerides can be monitored using blood tests.

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A short-term increase in triglycerides – a type of fat found in the blood – happens in 25% to 50% of isotretinoin patients, Suozzi said.

“We tolerate some level of elevation because it’s so common, but if it’s getting very high – like, above 800 mg/dL, when normal is 200 mg/dL or less – then you could consider discontinuing therapy,” she added.

Transient bumps in triglycerides typically don’t present major issues, Suozzi explained, but someone with very high levels may be at risk for pancreatitis, which can lead to life-threatening organ failure. High triglycerides can also increase the risk of heart disease.

This is why doctors have isotretinoin patients come back for follow-up blood tests to monitor triglyceride levels.

If your side effects are really harsh, your doctor can adjust your dose

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A lower dose means a longer course of treatment, but you may have more tolerable side effects.

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Sarah Schmalbruch/INSIDER

If isotretinoin side effects are really bothersome, adjusting your daily dose could help.

“The goal for isotretinoin is not a specific dose that you’re getting daily, it’s a total cumulative dose,” Suozzi said. “The higher the daily dose, the fast you’ll get to your total cumulative dose, but you’ll have likely more side effects.”

But a dermatologist can adjust your daily dose to make it lower and make side effects more tolerable, she explained. The only downside is that it’ll take a bit longer to reach your cumulative dose, which is based on weight.

In general, isotretinoin is well-tolerated

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See an experienced dermatologist to make sure you get the best care while on isotretinoin.

“If a patient has a history of course of suicidal ideation or active depression, you want to discuss with their psychiatrist and have them monitored closely if they’re going to be on the mediation,” Suozzi said.

“The key is to make sure you’re being treated by an experienced dermatologist, and that you are aware of all the side effects so that you can report them as soon as you are experiencing them,” Suozzi said. “And then your doses can be adjusted or the medication can be discontinued if necessary.”